Saturday, 22 September 2012

Parenthood: day thirty-two

Well well, we've had a fair amount of excitement since Oliver passed the four week mark, and I have alternated between being too busy and too lazy to document it all.

On Tuesday, we had a routine visit with the midwife, which was truly routine. She weighed him—nine pounds, fifteen ounces (4.51 kilos)—and answered some questions and then we were done. We said our goodbyes, since our final appointment in two weeks will be with our other midwife. The midwife care has been a great experience overall. They were very helpful and accommodating throughout the pregnancy, and they made several house visits in the first week after Oliver was born.

On the other hand, we've visited the Better Breastfeeding Clinic three times now, and the consultants we've seen there—one doctor and one nurse—have been a little surprised at what the midwives have omitted in their recent care. The clinicians have paid much more attention to his thrush and diaper rash, as well as a couple of other things that slip my mind at the moment, even though these things are not explicitly within their purview. But that's what doctors do, I think. They fuss a lot more about details. The important thing is that Oliver is healthy and has been healthy. And it was the midwife who recommended the breastfeeding clinic in the first place.

Regardless, I'm very happy that we had midwives, and we would certainly do so again.

So, on Wednesday, we had our first follow-up visit at the breastfeeding clinic. The doctor saw some improvement in Oliver's latch, but his feedings were still taking quite a long time and he was still doing a lot of fussing and causing Danijela pain, which was making things difficult for everyone.

While I've talked mostly about Oliver's sleeping and crying, it's feeding that has caused the most problems, and I think it is probably the main source of his other troubles. You might think that breastfeeding is the most natural thing in the world, since it's (well, was) fundamental to the survival of the human race, but it is not easy. In fact, it's probably the most difficult aspect of parenthood we've faced. A baby who doesn't latch properly will have trouble filling his stomach in a reasonable period of time. A baby who doesn't fill his stomach at a feeding will likely be cranky and not sleep properly, and it may be very difficult to determine the cause of the trouble. Indeed, it may be very difficult to determine the cause of a poor latch, let alone what to do about it. Not only that, improper latches can be painful for nursing mothers and make feedings excessively long. What a system, nature! We've experienced all of this with Oliver; hence our visits to the clinic, as well as another one at Toronto East General. Adding to the difficulty, Oliver is growing perfectly well and voiding regularly, so we have no reason to think that he's not getting enough milk.

I guess I only mentioned briefly our first visit to the clinic before. Well, at that meeting, the previous week, the doctor talked at us for an hour and a half and we left more confused than when we arrived. Despite the information overload, things did seem to improve afterward. The doctor offered more detail about the correct latch than we had previously, and some other reassurances. She also diagnosed his thrush; we already knew about the diaper rash.

Then she mentioned that Oliver might have a tongue tie, which neither Danijela nor I had heard of before, and suggested that releasing it might improve his latch. Surgery—yikes! A tongue tie occurs when the band of flesh anchoring the tongue to the bottom of the mouth (the frenulum) is too tight to allow free tongue movement. It's fairly common, which is a bit of an evolutionary mystery to me. Children generally grow out of it eventually, but it often interferes with breastfeeding. Releasing a tongue tie involves simply snipping the frenulum. There's little blood, and the baby goes straight to the breast afterward to eat, soothe, and heal. We weren't at all keen on the idea initially, but at our follow-up visit, we agreed that it would be a good idea at least to have the clinic's tongue-tie expert assess it and go from there. "Luckily", there was an appointment available the next day. It was all a bit of a rush and we are still hesitant to take him in the car, as he is unpredictable in his seat.

So, back we went on Thursday, to see another lactation consultant and the tongue-tie man. By this time, we'd already decided to go ahead with the tongue-tie release if the doctor recommended it. The risks are low, the potential benefits high, they could do the thing right there in the office, and the doc assured us he'd treated similar tongue ties many many times. We said yes—we are keen to try what we can to continue breastfeeding—and they did it. I had a brief moment of fear as they held Oliver down, opened his mouth, and inserted the scissors, but it was over before the fear set in (and before Danijela even realized), and there really was very little blood. He nursed immediately after, while the clinicians looked on and continued to fret over his latch.

Unfortunately, while the doctor was impressed with the release, the operation doesn't seem to have made any improvement yet. Indeed, Oliver seems to be having a little more difficulty latching since then, which one might expect with a completely different range of tongue motion. The lactation consultant has recommended craniosacral therapy for Oliver to relax his jaw and allow him to open his mouth wider, and we'll be trying that soon I guess—as long as the treatment is covered by my health insurance!

Let me leave it at that, and I'll probably forget to pick up the story between now and the next time.

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